1. Meningioma preceding CASPR2 antibody limbic encephalitis with a stroke mimic
- Author
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Xian-Kai Xu, Bao-Lin Shi, Yong-Xing Chen, Ran Li, and Xiao-Jin Lu
- Subjects
Autoimmune encephalitis ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Limbic encephalitis ,Autoantibody ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Gastroenterology ,Meningioma ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Paralysis ,Hypermetabolism ,030212 general & internal medicine ,medicine.symptom ,business - Abstract
Rationale Todd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room. Patient concerns We report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE. Diagnoses CASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE. Intervention The patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days). Outcomes Remission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 days. Lessons Autoimmune encephalitis (AE) should be considered in cases of late-onset epilepsy following meningioma peritumoral brain edema and resection. A diagnosis of AE should be considered in patients presenting with stroke-like symptoms if the magnetic resonance imaging abnormality does not match a known vascular territory. Early and correct diagnosis is crucial because immunotherapy is usually effective for this disease.
- Published
- 2021
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